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    ICD-9 code for Renal vein entrapment syndrome?

    Good morning everyone! My name is Denise and I am a certified coder and auditor for a nephrology practice. I have a dilemma, I have searched every which way possible on the web and posted this on...

    03-22-2013 03:15 PM

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    What you'll find inside 


    In The Gold Standard you can read and comment on articles. Ask Dr. Robert Gold documentation and coding questions in the Ask Dr. G forum. Communicate with your peers in CDItalk. See if you can solve the latest challenge in Clinical Conundrum.

    Become a part of DCBA Interactive today and participate in active learning. Welcome!

    DCBA for Children's Hospitals 




    DCBA has consultant teams dedicated to implementing documentation improvement programs in pediatric hospitals. We are proud to introduce our Pediatric Documentation Improvement website at www.dcbainc.com/childrens. We also have a Pediatric Section of our forum which will include Articles, Question and Answer, Clinical Conundrums and Discussions. As you know by now, physician to physician discussions regarding the doctor's specialty, talking about diseases the doctor sees and treats in the appropriate clinical terminology is the most powerful force in engaging a Medical Staff.

    Brian Murphy makes a surprise visit to the the Southeast US Chapter meeting of ACDIS 


    At the summer meeting of the Southeast Chapter of ACDIS held on June 15, 2012 at the Education Auditorium at Wellstar Kennestone Hospital in Marietta, Georgia, concomitant with the change of officers of the chapter, Brian Murphy, Director of ACDIS for HCPro made a surprise visit to congratulate the new officers. He updated the progress of ACDIS as an organization and presented the newest initiative of working with AHIMA to coordinate Query Guidelines between the two professional groups. He announced the growth of the national membership to approximately 3,200 members and recognized the expertise and enthusiasm of the CDI profession as one that has demonstrated significance for other national organizations, such as Magnet status of hospitals with the CCDS credential recognized for its value to hospitals. Expansion is underway for Outpatient, Long Term Acute Care and Pediatric specialties within the organization, as well.
    http://blogs.hcpro.com/acdis/2012/06...ew-leadership/

    518.52 and 518.82 Misdefined by NCHS - Lead to Bad Data 


    Stay tuned for descriptions and advice. Meantime, DON'T USE THESE CODES unless you know what you're doing. Check it out at the ACDIS site: http://www.hcpro.com/acdis/details.c...tent_id=271879 ...
    Read More Read More

    Documentation Strategies to Support Severity of Illness, Second Edition 


    Click here to get the latest edition of Documentation Strategies to Support Severity of Illness written by Dr. G. at the HCPro Marketplace. Many had enjoyed the First Edition. This one has several additional subjects, but also has national standards, clinical discussions and resources for the physician, the midlevel provider, the coder and the CDI specialist so you don't have to go hunting through the current medical literature for support. Get one for each CDI specialist to help with concurrent clarifications - get one for every coder to help with retrospective queries - get some for the entire medical staff! Several successful programs have done just that.


    If the Medical Staff Doesn't Get It, Nothing Else Matters!

    Pediatrics Patients are NOT Small Adults
    Children's Hospital CDI Program Needs Are Unique


    Consultants think that the same concepts as they provide to adult acute care hospitals apply across the board to children's hospitals. This is farthest from the truth. Pediatric cardiologists don't want to hear about chronic ischemic heart disease. Their neonatologists don't want to be educated in issues that apply to the geriatric age group. And children's hospitals in general are not so much interested in Medicare Severity DRGs. The needs of a Clinical Documentation Improvement Program in the children's hospitals in the country involve physicians talking decision making processes of pediatric disease in the language they understand and live with day to day.

    DCBA's physician, Registered Nurse and Professional Coding Consultants have had very satisfying experience in educating the docs, the midlevels, the coders and CDI team members in children's hospitals. Let our experience provide you with a happy experience.

    Dear SIRS - You Scare Us 


    International Panel Asserts
    SIRS + Infection Does NOT Equal Sepsis

    On March 29, 2012, HCPro broadcast an audioconference designed to help coding professionals, Clinical Documentation Improvement professionals and medical professionals understand the proper way to address sepsis in the medical record and how to avoid the trap of inappropriate billing for sepsis DRGs.

    Recognizing that the definitions of the 995.9x series of codes and the Official Coding Guidelines regarding the concept of SIRS in the face of infection are faulty, Robert S. Gold, MD gathered information from the medical literature and gained the support of nationally known experts in the field of sepsis.

    He engaged David Talan, MD, Professor of Medicine at UCLA School of Medicine, Chair of the Department of Emergency Medicine, Olive View-UCLA Medical Center and Faculty, Division of Infectious diseases to discuss the practical aspects of identifying patients who are sick and at risk of dying from severe infectious processes.
    Dr. Talan reviewed his experience and that of others in trying to utilize the SIRS criteria as a means of identifying if patients were at risk on initial triage in the Emergency Department. He noted that so many more patients with minimal infections or patients with noninflammatory processes such as congestive heart failure demonstrated two or more of the SIRS criteria than patients who were, indeed, septic that the SIRS criteria were of no benefit in predicting sepsis. He did confirm that a physician’s senses should be piqued if a sick patient were seen who did demonstrate white count deviations or variations in vital signs so that attention could be turned to evaluating if an inflammatory process was going on and, in that light, the criteria are valuable as a triage tool but nothing more. His editorial entitled “Dear SIRS: It’s time to return to sepsis as we’ve known it” attracted national discussion.

    Joining the discussion from London, England was Dr. Jonathan Ball, lecturer in Intensive Care Medicine who works both on the general adult and neuro Intensive Care Units at St. George’s Hospital, the university teaching hospital for southwest London and is on the Advisory Board of the professional journal Critical Care.
    Dr. Ball wrote the definitive article summarizing the 2002 international meeting designed to evaluate the then current definition of sepsis and provide insights as to the value of the SIRS criteria. At our conference, he provided insights as to the workup of the patient, who had been admitted through the Emergency Room, from the intensivist’s perspective and how his experience and that of others has led to the conclusion that the SIRS criteria alone may be a valuable screening tool to look further, but that virtually all patients in the critical care arena demonstrated vital sign or laboratory values that would meet the SIRS criteria, regardless of the cause of the abnormalities. From the viewpoint of a physician whose reimbursements are based on how sick the patient is determined by means other than ICD codes or E&M levels, he finds it perverse that SIRS should drive increased payments when that alone provides no evidence that the patient is even sick - that a constellation of variations in vital signs is not equivalent to “sepsis,” a condition that he knows carries significant potential for progression to organ failures and death.

    Dr. Gold presented published statements of Dr. Jean Louis Vincent, Head of Faculty, Department of Intensive Care, Erasme University, Brussels, Belgium, Secretary General of the World Federation of Societies of Critical Care Medicine, Editor in Chief of Critical Care and a participant in the 2002 international forum that attempted to put “Sepsis” into focus and to aid the intensivist in identifying patients who were at risk. He had been publishing since 1997 his own frustration with SIRS as a purported substitute for sepsis with such statements as, “Dear SIRS, I’m sorry to say I don’t like you.”

    The hope of this presentation was to help the audience recognize that it is more important to see the patient in order to try to make a determination as to how sick that patient is and not to rely on vague variances in vital signs or white blood cell count – to help the CDI specialist to not rely on vital sign variations to attempt to coerce medical staff cooperation in inappropriately reflecting a sick patient by documenting “meets two of the four criteria of SIRS” when the vital sign variances had nothing to do with an inflammatory process or where the infection was truly not at the point of representing sepsis – to help the medical staff or midlevel providers understand that the practice of medicine is a bedside process and that clinical evaluation should lead to ethical and knowledgeable documentation of findings and thought processes.

    Jennifer Avery, CCS, CPC-H, CPC, CPC-I, a senior regulatory specialist with the hosting HCPro of Danvers, MA and author of warnings to coding professionals regarding documented SIRS or sepsis (where the clinical course did not seem to support these conditions) presented the background for the proper coding of infections or noninfectious inflammatory processes that might drive a systemic response and the official guidelines and Coding Clinic advice on how to handle these conditions in ICD-9-CM codes. It became obvious that some of the definitions are truly inadequate now, as we have become more sophisticated in the workup of the sick patient and that the mandate to assign codes for sepsis when the patient’s presentation is obviously inconsistent with sepsis is not appropriate and should be updated.

    Interestingly, several audience participants reflected in the Q&A session that they have been denied payment for various sepsis discharges when the payer recognized that the patients were not sick, supporting the conclusions and advice of our panel.

    Our Docs Are Already Primed for ICD-10. Are Yours? 


    Since the introduction of ICD, the system has led to more and more reflection of pathogenesis of disease and specificity of descriptors. With ICD-10, this will be even more complete than ever. Why hasn't your program already achieved that buy-in by the medical staff? Have you been concentrating on buzz words or on pathogenesis of disease for the benefit of the patient workup and treatment plan?

    DCBA's programs have prepared Medical Staff members and their mid-levels, CDI specialists and coding professionals for this evolution for almost a decade. On review of the ICD-10 needed changes from our programs provided since 2002, there's not a lot new for the client hospitals to learn - they're already prepared for it - their Medical Staff members are already doing it.

    If you don't already have a program. a physician-led program is what you need. If you already have one without the strongest support of the medical staff, perhaps you need a boost. Give us a call.

    A PLAN FOR YOUR SURGEONS FOR ICD-10 NOW
    Guidelines Are Out Now for PCS

    “Many of the terms used to construct PCS codes are defined within the system. It is the coder’s responsibility to determine what the documentation in the medical record equates to in the PCS definition. The physician is not expected to use the terms used in PCS code descriptions, nor is the coder required to query the physician when the correlation between the documentation and the defined PCS terms is clear. Example: When the physician documents ‘partial resection,’ the coder can independently correlate ‘partial resection’ to the root operation Excision without querying the physician for clarification.”

    You must get ready for this NOW.

    As we know, procedure coding will be a totally new animal, from new terminology to ultra specificity regarding size, which piece of intestine, which specific artery or vein, which side of the body - things that ICD-9 never dreamed of! Here's a way to prepare your surgeons for ICD-10 and the electronic health record at the same time.

    Identify each of your surgeons. Identify the top ten procedures each performs. Have someone analyze the content of the description of the operation itself for five of each of his dictated cases. Look at the ICD-10 needs for that procedure that his current method of dictation misses and determine where the surgeon needs to provide additional or more specific information. Create a template for the procedure, leaving blanks with the potential options listed like a drop down menu. Also have a CPT coder validate that all is necessary on the template to provide the needs for the physician's CPT code assignment for each procedure. Prepare a section on the soon-to-be electronic version for the operative report with an area at the top for the surgeon to dictate his findings, fluid balance, estimated blood loss, etc. Below that, have the templated operative procedure. Have the surgeon go over the templates and make appropriate modifications, if any. Let the surgeon know that, for each time he does that procedure, he'll dictate the findings at operation and any odd events that happened during the case, fill in the spaces for the specificity in that template, then all he has to do is provide an electronic signature and the deed is done.

    Once each doc has performed this for his top procedures, expand the number of templates for each surgeon throughout year 2012. By the time 2013 starts (long before ICD-10 is mandatory), virtually all procedure coding will take care of itself and the surgeons will love having his specific templates and his CPT codes instantly at the end of each case.

    Analyze Your Clinical Documentation Improvement Program for Compliance - Are You A RAC Target? 


    In the June 1, 2010 issue of HIM Connection, HCPro warns about the necessity of developing a robust auditing process at your hospital with a coding manager leading the way. However, wouldn't you like to know if your coders are assigning codes to what the patient has is WRONG from a clinical perspective? Wouldn't you like to know if your CDI program is as clinically robust as it should be? Wouldn't you like to be assured that your program is not exposing you to RAC scrutiny - or, if it is, are your records immune to RAC scrutiny?

    A coding audit will only tell if your coders are assigning ICD-9-CM codes and DRGs based on the rules and based on what is written in the records. Sometimes that's not enough. If the physician states that a condition exists early in the stay and does not address that later - if the admitting physician identifies a serious condition and everyone else cuts and pastes - and a high weighted DRG is assigned when the patient does not have that condition, your hospital is at risk.

    If your CDI team is spending considerable time with administrative tasks that heep them from performing concurrent review, retrospective review, coordination of efforts with quality, infection control and patient safety, wouldn't it be nice to know how to improve effects and effectiveness of your program?

    DCBA's physician/coder review teams can fill these needs. Call us.

    DCBA Helps CMS 


    A recent web publication from the Medicare Learning Network, designed to help hospitals in RAC preparedness by emphasizing certain coding rules, contained some erroneous advice. Lynne Spryszak, RN, educator for HCPro, read it the day it came out and called Dr. Gold to discuss what she perceived to be a potential problem. Upon his review, it was apparent that the author of this piece based advice regarding the acceptability of assignment of "secondary" or "other" ICD codes on old guidelines. This had the potential to leave hospitals nationwide at risk of fines by the RACs for accepting diagnoses provided by other than the attending physician. Dr. Gold immediately contacted authorities at CMS, and particularly the Medicare Learning Network and explained the issue. Valerie A. Haugen, Director of Provider Information Planning and Development of CMS immediately pulled the piece and her team conferred with Sue Bowman, RHIA, CCS, Director of Coding Policy and Compliance of AHIMA and Nelly Leon Chisen, RHIA, Director of Coding and Classification of AHA and validated Dr. Gold's observations. Article #SE1028 was reissued October 29, 2010 with the correct advice regarding acceptable ICD codes for assignment as "secondary" or "other" diagnoses and hospitals are breathing a sigh of relief. This type of cooperation between CMS and the people in the field is exemplary and the responsiveness of the folks in Baltimore is appreciated.

    http://www.cms.gov/MLNMattersArticle...ads/SE1028.pdf